Key Points
• The treatment for refractory or relapsed non-Hodgkin lymphoma (r/r NHL) in children and adolescents is controversial. In order to make treatment recommendations, researchers pooled international experiences on re-induction treatment of r/r NHL, hematopoietic stem cell transplantation, and risk factors related to outcome representing 639 patients.
• “For r/r DLBCL,” the researchers wrote, “second-line treatment with (R)ICE became more common in the more recent period. This regimen leads to sufficient response allowing consolidation by HSCT in most patients. The standard of care for most r/r DLBCL is, therefore, RICE [rituximab, ifosfamide, carboplatin, etoposide] re-induction followed by autologous HSCT [hematopoietic stem cell transplant]. Cases with aggressive refractory disease or early progression may require more intensive treatment approaches like those for r/r Burkitt lymphoma. In rare individual cases with very late relapses, limited first-line treatment and favorable response to second-line therapy, HSCT may not be required for consolidation.”
• The authors anticipate that data from the current study will be used to select treatment for patients and plan future clinical trials. They stressed that additional intensification of re-induction treatment by means of cytostatic agents will not vanquish disease resistance or relapse. Instead, molecular profiling of disease and drugs with new mechanisms of actions will be necessary. Importantly, many new drugs are needed for B-cell malignancies.